<?php include'partials/header.php' ?>
<?php include'bdd/db.php' ?>
<body>
<nav id="myNavbar" class="navbar navbar-default navbar-inverse navbar-fixed-top" role="navigation">
	<!-- Brand and toggle get grouped for better mobile display -->
	<div class="container">
		<div class="navbar-header">
			<button type="button" class="navbar-toggle" data-toggle="collapse" data-target="#navbarCollapse">
				<span class="sr-only">Toggle navigation</span>
				<span class="icon-bar"></span>
				<span class="icon-bar"></span>
				<span class="icon-bar"></span>
			</button>
			<a class="navbar-brand" href="#">Prescription</a>
		</div>
		<!-- Collect the nav links, forms, and other content for toggling -->
		<div class="collapse navbar-collapse" id="navbarCollapse">
			<ul class="nav navbar-nav">
				<li class="active"><a href="index.php">Acceuil</a></li>
				<!--<li><a href="" target="_blank">About</a></li>
				<li><a href="" target="_blank">Contact</a></li>
				-->
			</ul>
		</div>
	</div>
</nav>
<div class="container">
<div id="inscription">
<div class="bs-example">
    <form class="form-horizontal">
        <div class="form-group">
            <label class="col-xs-2 control-label" for="inputSuccess">Email</label>
            <div class="col-xs-10">
                <input type="email" id="inputSuccess" class="form-control" placeholder="Email">
            </div>
        </div>
        <div class="form-group">
            <label class="col-xs-2 control-label" for="inputWarning">Mot de passe</label>
            <div class="col-xs-10">
                <input type="password" class="form-control" placeholder="Mot de passe">
            </div>
        </div>
		 <div class="form-group">
            <label class="col-xs-2 control-label" for="inputWarning">Mot de passe</label>
            <div class="col-xs-10">
                <input type="password" class="form-control" placeholder="Ressaisir votre mot de passe">
            </div>
        </div>
        <div class="form-group">
            <label class="col-xs-2 control-label" for="inputError">Nom</label>
            <div class="col-xs-10">
                <input type="text" id="inputError" class="form-control" placeholder="Nom">
            </div>
		</div>
		<div class="form-group">
            <label class="col-xs-2 control-label" for="inputError">Prénom</label>
            <div class="col-xs-10">
                <input type="text" id="inputError" class="form-control" placeholder="Prénom">
            </div>
		</div>
		<div class="form-group">
            <label class="col-xs-2 control-label" for="inputError">N° de rue</label>
            <div class="col-xs-10">
                <input type="text" id="inputError" class="form-control" placeholder="N° de rue">
            </div>
        </div>
		<div class="form-group">
            <label class="col-xs-2 control-label" for="inputError">Adresse</label>
            <div class="col-xs-10">
                <input type="text" id="inputError" class="form-control" placeholder="Adresse">
            </div>
        </div>
		<div class="form-group">
            <label class="col-xs-2 control-label" for="inputError">Ville</label>
            <div class="col-xs-10">
                <input type="text" id="inputError" class="form-control" placeholder="Ville">
            </div>
        </div>
		<div class="form-group">
            <label class="col-xs-2 control-label" for="inputError">Code postal</label>
            <div class="col-xs-10">
                <input type="text" id="inputError" class="form-control" placeholder="Code postal">
            </div>
        </div>
        </div>
		<div id="validation">
		<center>
		<button id="valider" type="submit" class="btn btn-success">Valider</button>
		<button id="valider" type="submit" class="btn btn">Annuler</button>
		</center>
		</div>
    </form>
</div>	
</body>
<?php include'partials/footer.php'?>

                             		                                		                                		                             		